Table of Contents
- English name
hypertensive heart disease
- Treatment department
- Multiple groups
High blood pressure patients
- H?frequent foci of disease
- H?common causes
Because of poor control of high blood pressure over the long term
- H?common symptoms
Chest tightness, dull pain and discomfort, Fatigue, Shortness of breath, etc.
Hypertensive heart diseasePathophysiological Ver?changes
1.Left ventricle?re hypertrophy (LVH)
LVH is a compensatory ver?change of the myocardium to an increasedhad blood pressure.The contractility?t of myocardium increases, to maintain adequate cardiac output.But a long time can cause cardiomyocyte hypertrophy,Thickening of the muscle fibers,Degeneration,The relative density of the capillaries decreased.Early myocardial remodeling,That meanst, centripetal remodeling,Cardiomyocyte hypertrophy,But the number doesn’t increaseThe order ?changes,He?hte collagen fibers,Allm?The accumulation of collagen exceeds 20% and fibrosis occurs.To replace cells who have lost their function,Thus, centripetal hypertrophy occurs,CloseLich an increase in volume load leads to eccentric hypertrophy.Hypertension LVH is reflected to?in the thickening of the ventricular septum.The latter is a h?an integral part of the cardiac limit cycle.It plays an important role in the systolic function of the left and right ventricles.
2.Decreased diastolic function
The diastolic heart failure is due to a decrease in the left ventricle?renal volume and an increase in end-diastolic blood pressure.LVEF is normal or slightly reduced.This is the mainto the normal ventricle?re contraction function attributed.The decreased ventricle?re muscle relaxation and compliance decrease the ventricular?right filling, to the ventricle?re filling to increasehen,The left ventricle needs to increase its inflation pressure.hen, to have a normal ventricle?re filling and maintaining a normal stroke volume.In addition, LVH makes cardiomyocytes hypertrophy,In particular, myocardial fibrosis ver?Does the pressure-volume ratio change?ltnis w?during the myocardial diastole.It receivedalso has the diastolic blood pressure in the heart?hey,Hence, LVH can cause diastolic dysfunction.Ver?changes in the structure and function of the heart in the early stages of hypertension,Diastolic dysfunction accounts for about 11%.
3.Decreased systolic function
It is known, that people with LVH a 10 times h?here have heart failure than people without LVH.This is because that long-term increases in pressure cause excessive afterload.Causes blood vessels?strong and concentric hypertrophy of the heart and diastolic relaxation musclesthe.CloseLich will there be a decrease in contractility?t of the myocardium.Enlarged hearthey,The end-diastolic volume of the ventricle increases,Both the ventricular?Both the filling pressure and the atrial pressure increased,The pulmonary ven?se backflow is blocked.Acute or chronic left heart failure with high blood pressure, Heart disease.
Hypertensive heart diseaseClinical manifestations
Early performance is usually atypical,The patient has m?Usually no obvious symptoms or only mild symptoms such as headache, Chest tightness, etc.These symptoms are main?general symptoms of high blood pressure,Nothing special.
Due to the high arterial pressure associated with high blood pressure,Block the heart from To pump bloodMyocardial hypertrophy and stiffness increase after long-term heavy work of the heart.CloseLich the pulmonary vein blood entering the heart is blocked.Formation of pulmonary congestion.The need for oxygen increases when myocardial hypertrophy occurs.The blood supply is relatively inadequate,Caused h?often heart failure.The clinical manifestations of diastolic heart failure and systolic heart failure are?like,Clinically difficult to distinguish.The clinical features of heart failure caused by high blood pressure are as follows:
(1) Due to an abnormal left ventricle?renal diastolic / systolic function May cause pulmonary congestionMain?as YsDyspnea from exertion; ②Short circuit lying on the back,Get better after you sit up.But have difficulty breathingIn severe F?The patient can wake up in his sleep. ④ In heavy F?llen k?Orientation breathing and coughing may occur.Cough-pink, frothy sputum.
(2) left heart failure can h?Often a decreased right ventricle?re function.Formation of total heart failure,Main?as ①The jugular vein is obviously full; ② the right upper abdomen is painful,Hepatomegaly; ③?the lower limb of both?en,In severe F?can a systemic?to occur: igur oliguria.
Hypertensive heart diseasean exam
The EKG can be normalLeft ventricular too?re hypertrophy and stress k?can occur.RV5 + SV1>4th0 mV (m?namely),RV5 + SV1> 3.5 mV (female),The ST segment in the lead, in which the R-wave dominates, can move down.Or T-wave inversion,The electric axis is offset to the left.
In addition to expanding the aorta, the aorta extends sinuously,The top of the aortic arch can reach or exceed the level of the sternoclavicular joint.The aortic node protrudes clearly to the left,Heart waist shows depression,Become a typical “aortic heart”.
(1) M-mode echocardiogram ①The thickness of the ventricular septum and the posterior wall of the left ventricle increases The ventricular?right septum and the posterior wall of the left ventricle are uniformly and symmetrically thickened.When is the absolute thickness of the interventricule?ren septum and the posterior wall of the left ventricle is larger than 12 mm,Can left ventricle?re diagnose hypertrophy.②The left ventricle?re myocardial weight is increasing The measurement of myocardial weight is an important indicator for assessing myocardial hypertrophy.In the past, could the tats?The real value of myocardial weight can only be understood through autopsy.In the past few years,A bige number of clinical studies has shown that the myocardial weight value obtained by echocardiography correlates strongly with the autopsy results.therefore,The American Society of Echocardiography recommends using the Devereux Correction Formula to calculate myocardial weight and myocardial mass index.
Left ventricle?res weight = 0.8 × 1.04 〔(LVDd + IVST + PWT) －LVDd) +0.6
Left ventricle?rer mass index (g / m) = left ventricular?res weight / K?body surfaceche
The normal value of the m?similar left ventricle?ren mass indexgt 135 g / m,Female 125 g / m
(2) Two-dimensional echocardiography The long axis of the left ventricle,The short axis view shows the hypertrophy of the left ventricular wall.Left ventricle?re hypertrophy occurs h?more common in concentric hypertrophy.Some are irregular hypertrophy,Concentric hypertrophy of the ventricular septum and the posterior wall of the left ventricle shows symmetrical hypertrophy.Irregular type is asymmetrical hypertrophy of the ventricular septum and the posterior wall of the left ventricle.The left ventricle?re H?hle is normal or slightly reduced.He?hte wall movement amplitude,The left atrium can be easily enlargedThe use of two-dimensional echocardiography to measure the left ventricle?ren myocardial thickness is more accurate than M-mode echocardiography.The heart failure phase of the systolic st?tion,The enlargement of the left atrium and left ventricle can also be seen.
(3) Doppler echocardiography The early heart contraction is highly dynamic.The peak speed of the aortic blood flow increasesStroke volume,The ejection fraction is normal,The mitral valve blood flow spectrum shows h?often different abnormal behaviorchanges on.When the left ventricle?re hypertrophy and diastolic compliance decrease,The left ventricle?re filling resistance increaseht,To maintain cardiac output,The main compensation mechanism is to increase the atrial inflation pressurehen.Manifested as verl?depressed isovolumic diastole of the left ventricle,E speed from tip to tip decreases,Acceleration time,Delay?ration time,The duration of the early diastole is lengthenedannoys,A tip to tip speed increasesThe I / O relationship?ltnis is decreasing,Do you reflect on the affected?left ventricular affected?re diastolic function.
(4) Tissue Doppler mitral valve annulus velocity Main?manifested as decreased diastolic function.Expressed as early diastolic velocity (E ‘) and sp?te diastolic velocity (A ‘) of the mitral valve ring,E ‘/ A'<1.For patients with restrictedwithout myocardial relaxation,E ‘decreases in the ground state,And it doesn’t increase with increasing tension like normal people do.so,Decreased E is one of the earliest manifestations of diastolic dysfunction.The guidelines of the Europ?ical society for cardiology assume that E / E ≥ 15 a left ventricle?re can diagnose diastolic dysfunction.If E / E is 8-15,Ben?Do you need another non-invasive diagnostic evidence of a left ventricle?ren diastolic dysfunction?Such as mitral valve or pulmonary vein blood flow spectrum, left ventricular?rer mass index etc.
Hypertensive heart diseasediagnosis
Have a history of high blood pressure.
There are only general symptoms of high blood pressure w?during the compensation period of the heart function, when the heart is not functioning properly?is permanently compensated.It k?Symptoms of left heart failure may occur.The light ones only have breathing difficulties after being tired,In severe F?llen sedentary breathing, cardiogenic asthma,Can it even cause an acute lung?to come Chronic disease patients k?Can Right Heart Failure Develop And Close?can lead to total heart failure.
It was determined, that the apical pulsation increased and rose,The heart circle widens to the lower left.The second hyperactivity?The heart tone in the area of the aortic valve can be metallic.The pulmonary valve auscultation area may have a second cardiac sound hypertrophy due to pulmonary hypertension.The apex area or (and) the aortic valve area k?call that systolic blasger?Ⅲ / Ⅳ h?ren.Diastolic gallop is too high at the apex of left heart failureren.If heart failure,Severe cyanosis of the skin and mucous membranesute, dilated jugular vein, Hepatomegaly, ?deme as well as chest and abdominal casts.
The ECG examination indicates a unilateral or bilateral ventricular?re hypertrophy and / or stress.P wave widens or notches appearThe P-wave connection potential (PTF-V1) in line V1 increases.Various arrhythmias, etc.The r?X-ray examination of the chest has enlarged the aorta.Left ventricle or whole heart enlargement,The pulmonary septal line appearsPulmonary congestion and so on.The echocardiography shows a unilateral or bilateral ventricular?re hypertrophy and enlargement.The left ventricle?re diastolic function decreased,Decreased ejection fraction, etc.
Hypertensive heart diseaseDifferential diagnosis
Hypertrophic cardiomyopathy: is a myocardial disease of unknown cause,It is characterized by asymmetrical hypertrophy of the ventricular wall,Often penetrates the ventricular septum,The chamber?hle is getting smaller,The blood filling of the left ventricle is blocked,The diastolic compliance of the left ventricle decreases.Depending on, whether the left ventricle?the right drainage system is blocked, it is divided into obstructive and non-obstructive hypertrophic cardiomyopathy.Can it be related to inheritance?nong.Clinically, it also showed symptoms of left heart failure,The k?physical examination shows increasedhte apical keysge.The EKG showed signs of a left ventricular?ren burden,However, echocardiography can best reduce asymmetric hypertrophy.run.And the age of onset is usually earlier,No history of hypertension can be identified.
Hypertensive heart diseasetreatment
1.Check your blood pressure early
Lowering blood pressure early is the main task in the treatment of hypertensive heart disease.The SBP target should be taken into account<140 mmHg.
2.The importance of reversing the LVH
The Framinghan Heart Study showed the LVH reduction through long-term follow-up best?does.The cardiovascular?re mortalite?t has decreased.The reverse of LVH includes non-pharmacological treatments: lifestyle optimization,Low Salt Ern?leadership, Control weight, Alcohol limit, Reduction of some sympathetic active hormones,How received?hte catecholamines, Activation of stress through the Renin Angiotensin System (RAS) and so on.Angiotensin Converting Enzyme Inhibitor (ACEI) and Angiotensin Converting Enzyme Receptor Antagonist (ARB) in antihypertensive drugs k?Can prevent LVH and myocardial fibrosis.Animal experiments and studies on humans have also best?tigt, that calcium antagonists (CCB) can reverse LVH?can.
3.Treatment of heart failure
Once the obvious symptoms of heart failure appear, the death rate is very high.Therefore it is necessary the pr?prevention and treatment of early asymptomatic heart failure (systolic or diastolic hypofunction)rken.In systolic heart failure It is recommended that Use ACEI.Beta blockers,Diuretics,ARB and / or aldosterone inhibitors,Reduce mortality and hospitalization rates.For hypertensive patients with diastolic heart failure (heart failure with conserved ejection fraction),So far there is no evidence that that antihypertensive therapy or antihypertensive drugs are beneficial.however,For these patients and those with hypertension and decreased systolic function, should consider reduce the SBP below 140 mmHg.
4thTreatment of combined coronary artery disease
There are many risk factors which can lead to coronary artery disease?can.However, blood pressure is one of the most important factors.Blood pressure values are widely associated with the risk of coronary artery disease.SBP>The risk of coronary artery disease increases sharply after 140 mmHg.For hypertensive patients with coronary artery disease,Decompression target value<140 mmHg.For patients with recent myocardial infarction, recommend the use of beta blockers.For other patients with coronary artery disease,All antihypertensive drugs are fineFrom the perspective of relieving symptoms of angina,Preferably recommend beta blockers and calcium antagonists.
5.Treatment of atrial fibrillation
Hypertension is the h?most common comorbidities?t of atrial fibrillation.It can also be a reversible pathogenic factor in atrial fibrillation.For patients with high blood pressure and atrial fibrillation,Should the risk of thromboembolism be complete?to be assessed.Unless, there are taboosOtherwise, most patients should receive oral anticoagulation therapy, to prevent stroke and other embolic events.In patients with hypertension and left ventricular?hypertrophy or heart failure It is recommended that To use AECI or ARB, to prevent the occurrence of atrial fibrillation. There are indications that that β-blockers and aldosterone antagonists can prevent the occurrence of atrial fibrillation?can.
Hypertensive heart diseaseprevention
1.This disease is a heart diseaseend, caused by a long-term rise in blood pressure and causing an overload of the heart.It is emphasized that lowering blood pressure early can prevent the occurrence and development of this disease.
2.Formal long-term antihypertensive treatment can reduce the degree of sch?improve the processing of the hypertrophic heart.Also completely restored to normal.A treatment plan who only emphasizes lowering blood pressure and neglects cardioprotection?ssigt, is incomplete?ndig and unscientific.